Asbestos project notification form, Oct 2002

NYC 9/11 Public Portal Document

NYC DEPARTMENT OF ENVIRONMENTAL (PROTECTION ll ~~~l 1 ~. W -FF- ~•°"* D~p GrroEPa;, `gym, Asbestos,Control Program 59-17 Junction Boulevard, 8 Floor, Corona, NY 11368-5107 Bulding or TRU No FOR OFFICULL USE ONLY ' ONLY TYPEWRITTEN f Sao "" ~p~° ASBESTOS PROJECT NOTIFICATION FORMS WILL ~ ... .. _ (ASBESTOS INSPECTION REPORT) 1, (S ACCEPTEDd%' " "" " ` Eovf tler • fee schedule)

with original hen submitting this form at the NYC Department of Buildings, the original form and three (3) copies This signatures are required. Submittal at the NYCDEP requires one copy of the form with original signatures. activities. form must be submitted to the NYC DEP not less than one week in advance of the start of abatement

1. FACILITY

2. Address 24 .Iol4N STaEr~T -- Borough MA1 Zip 1.0098 3. Block 6 4. Lot 2A AKA

5. Type of Facility_ M%X~ED USE 6. Name of Building

II. BUILDING OWNER

7. Name • . 8. Contact Person

9. Tel.# Fax #

City State _____ Zip 10. Address _

III. GENERAL CONTRACTOR

1 11. Name--

IV. ASBESTOS ABATEMENT CONTRACTOR --------- ------- -- Tel. # — ----

12. Name 6 1AM~fy_ VO2'ZBiW Il Sow CvNrR NC _ --- _13. Contact Person

14. Federal Employer ID. # PII _ 15. Tel. # ----- i 53 _ Fax # _._._._._._._._._

16. Address _1248 2-ALPIA -- - ------City _ P _ __ State Zip _A? _ V. THIRD PARTY AIR MONITOR

17. Name WA ?Ale- eu6iNEEeS __--_18. Contact Person MlCNAeL- NalnrJ

— Fax # f2121 3a 19. Federal Employer ID. # 1 PII — 20. Tel # Ez~2) 2X 2= aa7 1

21. Address — E hsr z28 4stu s'~~'r --_ City N~'u% Yoa~- ---_ State t`1~f Zip S~7 —_

22. Sample Analysis Laboratory_ ._. -_ -- — 23. NYS DOH ELAP #

VI. PROJECT INFORMATION 24.. Starting date for this portion of work - CJ10? -I o2_ Projected completion date tc',31 loz Asbestos work schedule ® Monday I Tuesday ® Wednesday ® Thursday ❑ Friday I Sunday

`o Shift from: _~_ ® am ❑ pm to `~ —0 am ® pm

If other, specify ---------- -------------------- -` neT 2 A?00 Access to inspect the premises must be provided during the work schedule indicated in this item. If si SURM

25. Total amount of asbestos-containing material to be abated during this work

__ 166869 __ Square Feet, and/or _—_--- Linear Feet

DECEIVED)2120017 '

NYC-WTC 000094378